Managed Care: A Legislator's Viewpoint

This article presents a congressman's view of managed care. A description of managed care is presented along with the overall purpose of this movement. Both the advantages and disadvantages of managed care are discussed as they have been presented on the legislative front.

I've often thought that managed care was a lot like little red sports cars. It works for some, and for others it's entirely impractical.

Managed care has literally swept the nation in recent years. In fact, some studies indicate that upward of 70 percent of all those who are eligible to enroll in a managed care plan have chosen to do so. This is a dramatic increase from the early 1990s, when fewer than half of all who were eligible opted for managed care.

As someone who manages a household budget, I can certainly understand the financial impetus behind managed care. Companies and government agencies that provide health care to their employees and their employee's families have seen huge increases in the cost of paying for insurance in recent years. In fact, the cost of health insurance has become so high that many employers find it difficult to offer their employee benefits.

Many of the principles behind managed care are sound, such as the need for preventive medicine. It makes sense that we as a nation should strive to be healthy and to take care of our bodies throughout our lives rather than letting our health deteriorate.

Many of the principles behind managed care are sound, such as the need for preventive medicine.

The fact that managed care plans provide services like immunizations and mammograms at little or no cost is a fine idea. It should not be the only consideration, however, when choosing a health care plan.

Many consumers are attracted to managed care plans, such as Health Maintenance Organizations (HMOs), because they feel the types of care received are equal to a fee-for-service structure, but less expensive. True, they will not have the level of access to specialists that they co-payments and deductibles. For someone who is young and healthy, someone who exercises regularly, watches his diet and has no chronic health problems, managed care may be the perfect solution. On the other hand, there are times when you need quick access to specialists and expensive testing is necessary. My fear, which is shared by many Americans, is that in our quest for keeping costs down we may be allowing medical care to deteriorate.

With as many as 50 million Americans enrolled in managed care plans, the for-profit plans are doing well financially. However, there are drawbacks to the consumer. For example, the concern among some is that doctors who administer care are not likely to inform their patients of all possible treatment and testing options, but rather just those that will be covered by the particular health plan. I have heard horror stories of patients having to wait a very long time for their general physician to actually refer them to specialists.

Another frequent complaint of managed care plans, and one we must take seriously, is the desire to keep people out of hospitals or to admit them for as short a time as possible.

I have also heard of cases where the general physician may not have sufficient knowledge about a certain medical condition to know whether treatment by a specialist is warranted or not. Of course, such a situation could have tragic consequences for the patient.

Another frequent complaint of managed care plans, and one we must take seriously, is the desire to keep people out of hospitals or to admit them for as short a time as possible. Obviously, shorter hospital stays represent a large cost-savings to the insurer. One big issue over the last year has been the 24-hour maternity stay that many insurers previously insisted upon. Before legislation was finally passed to remedy this practice, it was clear that many patients were sent home unprepared and ill informed.

Finally, I wanted to update you on legislation pending in the House of Representatives. On July 24, the House of Commerce Committee passed legislation that would prohibit health insurers from restricting what a physician can discuss with a patient. The Patient Right-to-Know Act was sponsored by my colleague, Congressman Greg Ganske of Iowa, a plastic surgeon. Ganske has argued that physicians often sign contracts with managed care and other insurance companies that effectively "gag" the physician. For example, the concern is that some doctors, by contractual agreement, will only notify their patients of health care options for which their plan is willing to pay. Rep. Ganske believes this is a critical issue of trust between the doctor and patient. I would hate to be in a situation where my child needed certain care but my physician could not inform me of every available option because of some ironclad contract with an insurer. This bill would authorize civil penalties of up to $25,000 for each offense where an insurer, either through written or oral communication, attempted to restrict doctors from disclosing medical information to patients. It is my understanding that the House leadership intends to bring this measure to the House Floor for a vote before the end of this legislative session.

Clearly legislators, health care professionals, and consumers need to closely monitor the managed care industry to make sure that medical quality is not compromised in order to achieve the highest profit. Those who have been well-served by managed care plans should be able to continue with their coverage, while those who have not received the kind of medical attention they deem proper should be allowed to find other affordable health care options.

The 104th Congress has made a huge commitment to address two key health care issues -- portability and pre-existing conditions. The recently passed "Health Care Affordability and Availability Act" will give millions of Americans peace of mind and a level of access to health care that many legislators, health care professionals, and consumers previously deemed unthinkable because of potential cost. I was proud to support this measure, and view it as an important first step in the bigger health car picture. Legislative oversight of all types of health care, be it managed or otherwise, must continue.

In the United States we are blessed to have the best-trained doctors and nurses in the world. As a country we must strive to make health care affordable and available so Americans can reap the benefits of the excellent care we have at our disposal.

Author

Steven C. LaTourette was sworn in as a member of the U.S. House of Representatives (19th District, Ohio) on January 4, 1995. He currently serves on the House Committee on Transportation and Infrastructure (formerly Public Works and Transportation). This committee has oversight of all federal highways, railroad, Army Corps of Engineers, U.S. Coast Guard and related infrastructure issues. LaTourette's subcommittee assignments are Public Buildings 7 Economic Development, Surface Transportation, and Water Resources & Environment. Additionally, LaTourette was appointed vice chairman of Investigations and Oversight for the Committee.

LaTourette also serves on the House Committee on Government Reform and Oversight (formerly Government Operations), which has oversight over all federal agencies, national monetary policies and government operation policies. He is assigned to the District of Columbia Subcommittee. Additionally, he serves on the House Committee on Small Business and its subcommittees on Tax & Finance and Government Programs.

In March 1995, LaTourette was appointed by House Speaker Newt Gingrich to serve on the U.S. Holocaust Memorial Council. Created in 1979 by President Jimmy Carter, the Council is charged with fostering remembrance in two ways: through annual national civic commemoration of Days of Remembrance of Holocaust Victims, and by raising funds for the U.S Holocaust Memorial Museum. Only five members of the House of Representatives serve on the Council. LaTourette is the only freshman on the Council.